What happened
On October 11, 2018, at approximately 21:00 UTC, an Agusta Westland A109E, registration PR-PMT, was performing a private passenger flight from São Paulo to the Iporanga-Guarujá Helipad. The aircraft was carrying two crew members and five passengers. During the final phase of the approach to the helipad, the helicopter experienced an abnormal loss of height and collided with the ground in a grassy area short of the paved landing surface.
The impact caused substantial damage to the aircraft, including broken main rotor blade connections, damage to the fuselage underside, a perforated tail boom, and a broken left main landing gear. Despite the severity of the impact, there were no injuries among the seven occupants.
The investigation
CENIPA's investigation established that the aircraft was operating outside of its prescribed weight and balance limits at the time of the accident. The crew had only been informed of the exact passenger weights upon boarding, a result of operational demands placed directly on the pilots by the aircraft owner.
Meteorological conditions at the destination were challenging, characterized by low ceilings, restricted visibility, light rain, and moderate turbulence. The investigation also noted that the aircraft had recently undergone significant maintenance, including the replacement of fuel tank cells, and had performed two test flights prior to the accident. During the first test flight, the crew had reported a discrepancy in the pitch control system (cyclic looseness).
Findings
- The aircraft was flying above the maximum weight and balance limits.
- The pilot performed a wide-angle approach at a speed lower than the prescribed 30 knots, which likely induced a Vortex Ring State (VRS).
- The crew's decision-making was influenced by professional pressure, as the pilot expressed fear of job loss if the flight was not completed despite unfavorable weather.
- Geographical constraints around the helipad limited the available approach paths and hindered the ability to execute a missed approach.
- The crew's ability to assess risks was compromised by the need to fulfill the mission under pressure from the aircraft owner.